Individual
SHAWN D GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 S UTICA AVE, TULSA, OK 74104-4012
(918) 579-7720
Mailing address
PO BOX 52750, KNOXVILLE, TN 37950-2750
(865) 766-8897
(865) 766-8874
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
38822
KY
2085R0202X
Diagnostic Radiology Physician
Primary
38822
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200513800
—
IN
05
—
64110307
—
KY
Enumeration date
06/13/2005
Last updated
01/30/2013
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